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Participant name __________________________________________
Address___________________________City:________________
State_____ZipCode_____________Email__________________
Website_________________ Telephone_____________ ____________
I, ____________ (name of Artist)_____________ (mark )
Poet ______ Music_____ Painter______ Sculptor______
Photographer ______Other_______________ wish to participate in the event organized by the Piag Museum.
a)________ Pelican Island June 2008
b)________ St Thomas University June 21st, 2008 - There is a special fee for students of St Thomas University.
c)________ other__________________________________________________________________________
For this event the Piag Museum will provide a cube with the measures of 12”x12”x12” in which I will make my Art using light materials and no-contaminants.
Choose one:
A) I will come to Piag Museum to pick up the Cube _______
B) It will be sent to me to the above address _______
The cube will be donated by me to PIAG Museum if I choose to.
Together with other artists I will place my Art at the location (Artist need to be present)
Piag Museum will inform me of the place and time that the event will occur.
I will send 5 digital images to the Museum one for each cube and I authorized Piag Museum to reproduce this images to promote the event.
In this act I give PIAG Museum the amount of one hundred Seventy five dollars ($175.00) non-refundable to
cover logistic expenses and publicity of the event. For artist who already paid that amount, it will be only a donation of $___________to Piag Museum. The PIAG MUSEUM is a 501(c)(3) organization and all donations are tax deductible.
Check No: ____________
Money order No: ___________
Cash: ___________
Signature of the Participant ___________________________Date_____________
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